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Humana Gold Plus H2486-005 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H2486-005 (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Gold Plus H2486-005 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H2486-005 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in ID. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H2486-005 (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Humana Gold Plus H2486-005 (HMO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Humana Gold Plus H2486-005 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $200.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6400.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Humana Gold Plus H2486-005 (HMO) prescription drug plan features an annual drug deductible of $200. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at standard pharmacies or through preferred mail order. Tier 2 generic prescriptions cost a $10 copay for a 1-month supply at standard pharmacies and preferred mail order, with preferred mail order offering no copay for a 3-month supply. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply and between $131 and $141 for a 3-month supply depending on your pharmacy choice. Tier 4 non-preferred drugs carry a 49% coinsurance for both 1-month and 3-month supplies. Tier 5 specialty drugs require a 30% coinsurance for a 1-month supply across standard pharmacies and mail order options.
Additional Benefits
The Humana Gold Plus H2486-005 (HMO) plan offers comprehensive coverage for core medical services, featuring no copay and no coinsurance for primary care visits, preventive care, and home health services. Specialist office visits require a $30 copay, while inpatient hospital stays require a $495 copay per day for the first five days, followed by no copay for additional days. Emergency room visits carry a $130 copay, which is waived if you are admitted to the hospital within 24 hours. For supplemental care, the plan provides routine vision exams and eyewear with no copay up to a $250 annual limit, alongside dental benefits with no copay and 0% to 40% coinsurance up to a $1,000 annual limit. Routine hearing exams also have no copay, while prescription hearing aids require a copay ranging from $699 to $999. Additionally, durable medical equipment, prosthetics, and dialysis services are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Humana Gold Plus H2486-005 (HMO) covers inpatient acute hospital stays with no coinsurance, requiring a $495 copay for days 1 through 5 and no copay for days 6 and beyond, excluding upgrades and non-Medicare-covered stays. Inpatient psychiatric hospital care is also covered with no coinsurance, featuring a $468 copay for days 1 through 5 and no copay for days 6 through 90, though additional psychiatric days are not covered. Prior authorization is required for both of these inpatient hospital benefits.
Outpatient Services See details
Humana Gold Plus H2486-005 (HMO) covers outpatient services with no coinsurance, including outpatient hospital services with a copay ranging from no copay to $495 and observation services with a $495 copay per stay. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require no coinsurance and a copay ranging from no copay to $35.
Partial Hospitalization See details
Humana Gold Plus H2486-005 (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
Humana Gold Plus H2486-005 (HMO) covers ambulance services with no coinsurance, requiring a $335 copay for ground transport and a $1,250 copay for air transport. For transportation services, some services are covered, but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Humana Gold Plus H2486-005 (HMO) covers emergency services with a $130 copay, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $50 copay, both with no coinsurance and no deductible. Worldwide emergency, urgent, and transportation services are also covered with a $130 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H2486-005 (HMO) covers primary care, mental health, and psychiatric services with no copay and no coinsurance, while specialists require a $30 copay and therapy services require a $45 copay, both with no coinsurance. Podiatry is not covered, and chiropractic services are only partially covered, excluding routine and other chiropractic care.
Preventive Services See details
Preventive Services are partially covered under the Humana Gold Plus H2486-005 (HMO) plan with no copay and no coinsurance for covered benefits such as annual physical exams, kidney disease education, glaucoma screenings, diabetes self-management, digital rectal exams, EKGs, and a memory fitness benefit. Uncovered services include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access, home safety modifications, and counseling.
Hearing Services See details
Hearing services are covered by Humana Gold Plus H2486-005 (HMO), featuring no copay for annual routine exams and fitting evaluations, and a $30 copay for Medicare-covered exams, all with no coinsurance. Prescription hearing aids are partially covered with a $699 to $999 copay and no coinsurance for up to two aids yearly, but OTC hearing aids and inner-ear, outer-ear, and over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by Humana Gold Plus H2486-005 (HMO), offering one routine eye exam and eyewear, such as contact lenses or eyeglasses, with no copay and no coinsurance up to a $250 annual limit. Other eye exam services, separate eyeglass lenses, eyeglass frames, and upgrades are not covered, and prior authorization is required.
Dental Services See details
Humana Gold Plus H2486-005 (HMO) features partially covered dental services, offering Medicare-covered dental care for a $30 copay and no coinsurance, alongside other covered services with no copay and 0% to 40% coinsurance up to a $1,000 annual limit. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Humana Gold Plus H2486-005 (HMO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Medicare Part B chemotherapy and other drugs have no copay and coinsurance ranging from no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and coinsurance ranging from no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by the Humana Gold Plus H2486-005 (HMO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment benefits under the Humana Gold Plus H2486-005 (HMO) plan cover durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $10 copay and applicable coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Gold Plus H2486-005 (HMO) with prior authorization required. Diagnostic procedures and tests carry a $0 to $50 copay with no coinsurance, therapeutic radiological services require a 20% coinsurance with no copay, and lab, outpatient X-ray, and diagnostic radiological services are available with no copay or coinsurance.
Home Health Services See details
Humana Gold Plus H2486-005 (HMO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Humana Gold Plus H2486-005 (HMO) with no coinsurance and prior authorization required, though only some services are covered. Specifically, standard cardiac, intensive cardiac, pulmonary rehabilitation, and SET for PAD services are not covered in practice, carrying a $10 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Gold Plus H2486-005 (HMO) with no coinsurance, requiring a $10 daily copay for days 1 to 20, a $218 daily copay for days 21 to 55, and no copay for days 56 to 100. Prior authorization is required, a prior three-day inpatient hospital stay is not needed, and additional days beyond the standard 100-day Medicare benefit are not covered.
Other Services See details
Humana Gold Plus H2486-005 (HMO) partially covers other services, offering acupuncture with a $30 copay and no coinsurance for up to 20 treatments per year, alongside chronic illness meal benefits with no copay and no coinsurance. Both of these covered benefits require prior authorization, while over-the-counter (OTC) items are not covered.
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